Compliance: Combat the 10 Most Common Claims Mistakes With This Expert Advice

Why This Topic Matters

Small formatting or submission errors can lead to rejected or delayed Medicare claims. The article helps readers understand which operational areas are most often scrutinized so they can decide whether the full guidance is relevant to their workflow.

Article Sections

1. Submitting claims on paper when exceptions do not apply

   Discusses electronic claim submission expectations and the limited circumstances in which paper filing may still be relevant. References Medicare Part B claim submission requirements and related exceptions.

2. Using photocopied CMS-1500 forms

   Covers paper form integrity and appearance considerations for the CMS-1500. Includes general presentation issues such as copying and formatting.

3. Listing too many lines of service

   Addresses limits on the number of service lines entered on a claim form and the need for additional forms when more services must be reported.

4. Writing explanations of services

   Explains why narrative descriptions should not be placed on the claim form and instead focuses on standard reporting elements. Mentions CPT, HCPCS, and ICD-10 reporting at a broad level.

5. Using special characters

   Discusses punctuation and other special characters that should be removed from claim forms. Also addresses formatting concerns related to ICD-10 entry.

6. Waiting over a year to file a claim

   Summarizes Medicare claim filing timeliness and the consequences of missing the filing window. Also references limited exception categories and the legal background for the time limit.

7. Line item 19 considerations

   Covers situations where additional information may be needed on the CMS-1500 and the types of claims that may trigger that requirement. Includes broad references to unlisted and not otherwise classified items.

8. Adding appropriate diagnoses

   Addresses diagnosis reporting on the claim form and the importance of specificity. Focuses on claim-level diagnosis documentation rather than clinical content.

9. Knowing whether to accept assignment

   Explains the claim form assignment area and the concept of mandatory assignment for certain providers and claim types. Discusses the topic as a billing workflow issue.

10. Allocating payment to the beneficiary when not applicable

    Covers the claim form area related to prior payment and how payment allocation can affect who receives reimbursement. Focuses on form completion and payer processing context.